FABRICIO FERREIRA COELHO

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Instituto Central, Hospital das Clínicas, Faculdade de Medicina
LIM/02 - Laboratório de Anatomia Médico-Cirúrgica, Hospital das Clínicas, Faculdade de Medicina

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  • article 3 Citação(ões) na Scopus
    Propensity Score-Matching Analysis Comparing Robotic Versus Laparoscopic Limited Liver Resections of the Posterosuperior Segments An International Multicenter Study
    (2024) KRENZIEN, Felix; SCHMELZLE, Moritz; PRATSCHKE, Johann; FELDBRUEGGE, Linda; LIU, Rong; LIU, Qu; ZHANG, Wanguang; ZHAO, Joseph J.; TAN, Hwee-Leong; CIPRIANI, Federica; HOOGTEIJLING, Tijs J.; AGHAYAN, Davit L.; FRETLAND, Asmund A.; SIOW, Tiing Foong; LIM, Chetana; SCATTON, Olivier; HERMAN, Paulo; COELHO, Fabricio F.; MARINO, Marco V.; MAZZAFERRO, Vincenzo; CHIOW, Adrian K. H.; SUCANDY, Iswanto; IVANECZ, Arpad; CHOI, Sung Hoon; LEE, Jae Hoon; GASTACA, Mikel; VIVARELLI, Marco; GIULIANTE, Felice; VALLE, Bernardo Dalla; RUZZENENTE, Andrea; YONG, Chee-Chien; CHEN, Zewei; YIN, Mengqiu; FONDEVILA, Constantino; EFANOV, Mikhail; MORISE, Zenichi; BENEDETTO, Fabrizio Di; BRUSTIA, Raffaele; VALLE, Raffaele Dalla; BOGGI, Ugo; GELLER, David; BELLI, Andrea; MEMEO, Riccardo; GRUTTADAURIA, Salvatore; MEJIA, Alejandro; PARK, James O.; ROTELLAR, Fernando; CHOI, Gi-Hong; ROBLES-CAMPOS, Ricardo; WANG, Xiaoying; SUTCLIFFE, Robert P.; HASEGAWA, Kiyoshi; TANG, Chung-Ngai; CHONG, Charing C. N.; LEE, Kit-Fai; MEURS, Juul; D'HONDT, Mathieu; MONDEN, Kazuteru; LOPEZ-BEN, Santiago; KINGHAM, T. Peter; FERRERO, Alessandro; ETTORRE, Giuseppe M.; PASCUAL, Franco; CHERQUI, Daniel; ZHENG, Junhao; LIANG, Xiao; SOUBRANE, Olivier; WAKABAYASHI, Go; TROISI, Roberto I.; CHEUNG, Tan-To; KATO, Yutaro; SUGIOKA, Atsushi; DOKMAK, Safi; D'SILVA, Mizelle; HAN, Ho-Seong; NGHIA, Phan Phuoc; LONG, Tran Cong Duy; HILAL, Mohammad Abu; CHEN, Kuo-Hsin; FUKS, David; ALDRIGHETTI, Luca; EDWIN, Bjorn; GOH, Brian K. P.
    Objective: The purpose of this study was to compare the outcomes of robotic limited liver resections (RLLR) versus laparoscopic limited liver resections (LLLR) of the posterosuperior segments.Background: Both laparoscopic and robotic liver resections have been used for tumors in the posterosuperior liver segments. However, the comparative performance and safety of both approaches have not been well examined in the existing literature.Methods: This is a post hoc analysis of a multicenter database of 5446 patients who underwent RLLR or LLLR of the posterosuperior segments (I, IVa, VII, and VIII) at 60 international centers between 2008 and 2021. Data on baseline demographics, center experience and volume, tumor features, and perioperative characteristics were collected and analyzed. Propensity score-matching (PSM) analysis (in both 1:1 and 1:2 ratios) was performed to minimize selection bias.Results: A total of 3510 cases met the study criteria, of whom 3049 underwent LLLR (87%), and 461 underwent RLLR (13%). After PSM (1:1: and 1:2), RLLR was associated with a lower open conversion rate [10 of 449 (2.2%) vs 54 of 898 (6.0%); P=0.002], less blood loss [100 mL [IQR: 50-200) days vs 150 mL (IQR: 50-350); P<0.001] and a shorter operative time (188 min (IQR: 140-270) vs 222 min (IQR: 158-300); P<0.001]. These improved perioperative outcomes associated with RLLR were similarly seen in a subset analysis of patients with cirrhosis-lower open conversion rate [1 of 136 (0.7%) vs 17 of 272 (6.2%); P=0.009], less blood loss [100 mL (IQR: 48-200) vs 160 mL (IQR: 50-400); P<0.001], and shorter operative time [190 min (IQR: 141-258) vs 230 min (IQR: 160-312); P=0.003]. Postoperative outcomes in terms of readmission, morbidity and mortality were similar between RLLR and LLLR in both the overall PSM cohort and cirrhosis patient subset.Conclusions: RLLR for the posterosuperior segments was associated with superior perioperative outcomes in terms of decreased operative time, blood loss, and open conversion rate when compared with LLLR.
  • article 8 Citação(ões) na Scopus
    Extended right hepatectomy with caudate lobe resection using the hilar ""en bloc"" resection technique with a modified hanging maneuver
    (2016) PERINI, Marcos V.; COELHO, Fabricio F.; KRUGER, Jaime A.; ROCHA, Flavio G.; HERMAN, Paulo
    The hanging liver maneuver is a useful technique to guide the transection of liver parenchyma by lifting a tape passed between the anterior surface of the inferior vena cava and the liver. Modified hanging liver maneuvers have been described in different types of liver resection. Surgical resection of hilar cholangiocarcinoma can involve the portal vein and the caudate lobe for margin clearance. However, hilar dissection and resection of the caudate lobe can be a challenging during the hanging maneuver once the tape is positioned. Herein, we describe a modified hanging liver maneuver for a hilar en bloc extended right hepatectomy with portal vein resection for the treatment of hilar cholangiocarcinoma including the caudate lobe. J. Surg. Oncol. 2016;113:427-431. (c) 2016 Wiley Periodicals, Inc.
  • article 1 Citação(ões) na Scopus
    DOES THE DROP IN PORTAL PRESSURE AFTER ESOPHAGOGASTRIC DEVASCULARIZATION AND SPLENECTOMY INFLUENCE THE VARIATION OF VARICEAL CALIBERS AND THE REBLEEDING RATES IN SCHISTOSOMIASIS IN LATE FOLLOW-UP?
    (2021) SILVA-NETO, Walter de Biase; QUIRESE, Claudemiro; MOURA, Eduardo Guimaraes Horneaux de; COELHO, Fabricio Ferreira; HERMAN, Paulo
    Background: The treatment of choice for patients with schistosomiasis with previous episode of varices is bleeding esophagogastric devascularization and splenectomy (EGDS) in association with postoperative endoscopic therapy. However, studies have shown varices recurrence especially after long-term follow-up. Aim: To assess the impact on behavior of esophageal varices and bleeding recurrence after post-operative endoscopic treatment of patients submitted to EGDS. Methods: Thirty-six patients submitted to EGDS were followed for more than five years. They were divided into two groups, according to the portal pressure drop, more or less than 30%, and compared with the behavior of esophageal varices and the rate of bleeding recurrence. Results: A significant reduction on the early and late post-operative varices caliber when compared the pre-operative data was observed despite an increase in diameter during follow-up that was controlled by endoscopic therapy. Conclusion: The drop in portal pressure did not significantly influence the variation of variceal calibers when comparing pre-operative and early or late post-operative diameters. The comparison between the portal pressure drop and the rebleeding rates was also not significant.
  • article 36 Citação(ões) na Scopus
    Laparoscopic vs. open left lateral sectionectomy: An update meta-analysis of randomized and non-randomized controlled trials
    (2019) MACACARI, Rodrigo Luiz; COELHO, Fabricio Ferreira; BERNARDO, Wanderley Marques; KRUGER, Jaime Arthur Pirola; JEISMANN, Vagner Birk; FONSECA, Gilton Marques; CESCONETTO, Danielle Menezes; CECCONELLO, Ivan; HERMAN, Paulo
    Background: Left lateral sectionectomy (LLS) is thought to be the anatomical liver resection most suitable for the laparoscopic approach. Despite increasing popularity, comparative analysis of laparoscopic and open LLS are mostly limited to retrospective, underpowered studies with small sample size. Recent population-based studies and prospective trials have generated new data; however, this new body of knowledge has not been submitted systematic reviews or meta-analyses and high quality evidence regarding the actual benefits of minimally invasive LLS is lacking. Methods: Systematic review of studies published until December 31st, 2017 and indexed in Medline, EMBASE, Cochrane Library Central and Scielo/LILACS databases. Randomized controlled trials and observational studies comparing perioperative results of laparoscopic and open LLS were included. Studies with patients submitted to LLS for living donation were excluded. Treatment outcomes, including conversion rates, estimated blood loss, transfusion rates, operative time, length of in-hospital stay, morbidity and mortality rates, were evaluated. Results: The primary search yielded 2838 articles, 23 of which (21 observational studies and 2 randomized controlled trials; 3415 patients) were included in the meta-analysis. Overall conversion rate was 7.4%. Patients submitted to laparoscopic LLS had less blood loss (mean difference, MD = - 119.81 ml, 95% CI = - 127.90, - 111.72, P < .00001, I-2 = 32%, N = 618), lower transfusion rates (4.1% vs. 10.1%; risk difference, RD = - 0.06, 95% CI = - 0.08, - 0.05, P < .00001, I-2 = 13%, N = 2968) and shorter length of in-hospital stay (MD = - 2.02 days, 95% CI = - 2.15, - 1.89, P < .00001, I-2 = 77%, N= 3160) compared to those undergoing open surgery. Marginally decreased overall complication (21.4% vs. 27.5%; RD = -0.03, 95% CI = - 0.06, 0.00, P =. 05, I-2 = 0%, N= 3268) and perioperative mortality (0.3% vs. 1.5%; RD = - 0.01, 95% CI = - 0.02, - 0.00, P =. 01, I-2 = 0%; N= 3332) rates were also observed. Operative time and biliary, cardiac or pulmonary complication rates did not differ significantly between groups. Conclusion: Current evidence supports the safety and feasibility of laparoscopic LLS. The laparoscopic approach is associated with reduced blood loss, lower transfusion rates and shorter length of in-hospital stay and should be considered the gold-standard for LLS.
  • article 1 Citação(ões) na Scopus
    Combined liver and multivisceral resections: A comparative analysis of short and long-term outcomes
    (2020) JUNIOR, Sergio S.; COELHO, Fabricio F.; TUSTUMI, Francisco; CASSENOTE, Alex J. F.; JEISMANN, Vagner B.; FONSECA, Gilton M.; KRUGER, Jaime A. P.; ERNANI, Lucas; CECCONELLO, Ivan; HERMAN, Paulo
    Background En bloc liver and adjacent organs resections are technically demanding procedures. Few case series and nonmatched comparative studies reported the outcomes of multivisceral liver resections (MLRs). Objectives To compare the short and long-term outcomes of patients submitted MLRs with those submitted to isolated hepatectomies. Methods From a prospective database, a case-matched 1:2 study was performed comparing MLRs and isolated hepatectomy. Additionally, a risk analysis was performed to evaluate the association between MLRs and perioperative morbidity, mortality, and long-term survival. Results Fifty-three MLRs were compared with 106 matched controls. Patients undergoing MLRs had longer operative time (430 [320-525] vs 360 [270-440] minutes,P = .005); higher estimated blood loss (600 [400-800] vs 400 [100-600] mL;P = .011); longer hospital stay (8 [6-14] vs 7 [5-9] days;P = .003); and higher postoperative mortality (9.4% vs 1.9%,P = .042). Number of resected organs was not an independent prognostic factor for perioperative major complications (odds ratio [OR], 1 organ = 1.8 [0.54-6.05]; OR >= 2, organs = 4.0 [0.35-13.84]) or perioperative mortality (OR, 1, organ = 5.2 [0.91-29.51]; OR >= 2, organs = 6.5 [0.52-79.60]). No differences in overall (P = .771) and disease-free survival (P = .28) were observed. Conclusion MLRs are feasible with acceptable morbidity but relatively high perioperative mortality. MLRs did not negatively affect long-term outcomes.
  • article 1 Citação(ões) na Scopus
    Impact of body mass index on perioperative outcomes of laparoscopic major hepatectomies
    (2023) BERARDI, Giammauro; KINGHAM, T. Peter; ZHANG, Wanguang; SYN, Nicholas L.; KOH, Ye-Xin; JABER, Bashar; AGHAYAN, Davit L.; SIOW, Tiing Foong; LIM, Chetana; SCATTON, Olivier; HERMAN, Paulo; COELHO, Fabricio Ferreira; MARINO, Marco V.; MAZZAFERRO, Vincenzo; CHIOW, Adrian K. H.; SUCANDY, Iswanto; IVANECZ, Arpad; CHOI, Sung Hoon; LEE, Jae Hoon; GASTACA, Mikel; VIVARELLI, Marco; GIULIANTE, Felice; DALLA, Bernardo; RUZZENENTE, Andrea; YONG, Chee-Chien; CHEN, Zewei; YIN, Mengqiu; FONDEVILA, Constantino; EFANOV, Mikhail; MORISE, Zenichi; BENEDETTO, Fabrizio Di; BRUSTIA, Raffaele; VALLE, Raffaele Dalla; BOGGI, Ugo; GELLER, David; BELLI, Andrea; MEMEO, Riccardo; GRUTTADAURIA, Salvatore; MEJIA, Alejandro; PARK, James O.; ROTELLAR, Fernando; CHOI, Gi-Hong; ROBLES-CAMPOS, Ricardo; WANG, Xiaoying; SUTCLIFFE, Robert P.; SCHMELZLE, Moritz; PRATSCHKE, Johann; LAI, Eric C. H.; CHONG, Charing C. N.; MEURS, Juul; D'HONDT, Mathieu; MONDEN, Kazuteru; LOPEZ-BEN, Santiago; LIU, Qu; LIU, Rong; FERRERO, Alessandro; ETTORRE, Giuseppe Maria; CIPRIANI, Federica; PASCUAL, Franco; CHERQUI, Daniel; ZHENG, Junhao; LIANG, Xiao; SOUBRANE, Olivier; WAKABAYASHI, Go; TROISI, Roberto I.; CHEUNG, Tan-To; KATO, Yutaro; SUGIOKA, Atsushi; D'SILVA, Mizelle; HAN, Ho-Seong; NGHIA, Phan Phuoc; LONG, Tran Cong duy; EDWIN, Bjorn; FUKS, David; HILAL, Mohammad Abu; ALDRIGHETTI, Luca; CHEN, Kuo-Hsin; GOH, Brian K. P.
    Background: Data on the effect of body mass index on laparoscopic liver resections are conflicting. We performed this study to investigate the association between body mass index and postoperative out-comes after laparoscopic major hepatectomies. Methods: This is a retrospective review of 4,348 laparoscopic major hepatectomies at 58 centers between 2005 and 2021, of which 3,383 met the study inclusion criteria. Concomitant major operations, vascular resections, and previous liver resections were excluded. Associations between body mass index and perioperative outcomes were analyzed using restricted cubic splines. Modeled effect sizes were visually rendered and summarized. Results: A total of 1,810 patients (53.5%) had normal weight, whereas 1,057 (31.2%) were overweight and 392 (11.6%) were obese. One hundred and twenty-four patients (3.6%) were underweight. Most peri-operative outcomes showed a linear worsening trend with increasing body mass index. There was a statistically significant increase in open conversion rate (16.3%, 10.8%, 9.2%, and 5.6%, P < .001), longer operation time (320 vs 305 vs 300 and 266 minutes, P < .001), increasing blood loss (300 vs 300 vs 295 vs 250 mL, P = .022), and higher postoperative morbidity (33.4% vs 26.3% vs 25.0% vs 25.0%, P = .009) in obese, overweight, normal weight, and underweight patients, respectively (P < .001). However, post-operative major morbidity demonstrated a ""U""-shaped association with body mass index, whereby the highest major morbidity rates were observed in underweight and obese patients. Conclusion: Laparoscopic major hepatectomy was associated with poorer outcomes with increasing body mass index for most perioperative outcome measures. & COPY; 2023 Elsevier Inc. All rights reserved.
  • article 4 Citação(ões) na Scopus
    Two decades of liver resection with a multidisciplinary approach in a single institution: What has changed? Analysis of 1409 cases
    (2022) HERMAN, Paulo; FONSECA, Gilton Marques; COELHO, Fabricio Ferreira; KRUGER, Jaime Arthur Pirola; MAKDISSI, Fabio Ferrari; JEISMANN, Vagner Birk; CARRILHO, Flair Jose; D'ALBUQUERQUE, Luiz Augusto Carneiro; NAHAS, Sergio Carlos
    Objectives: To evaluate results of patients undergoing liver resection in a single center over the past two decades with a particular look at Colorectal Liver Metastasis (CRLM) and Hepatocellular Carcinoma (HCC). Method: Patients were divided into two eras, from 2000 to 2010 (Era 1) and 2011 to 2020 (Era 2). The most frequent diagnosis was CRLM and HCC, with 738 (52.4%) and 227 (16.1%) cases respectively. An evaluation of all liver resection cases and a subgroup analysis of both CRLM and HCC were performed. Preoperative and per operative variables and long-term outcomes were evaluated. Results: 1409 liver resections were performed. In Era 2 the authors observed higher BMI, more: minimally invasive surgeries, Pringle maneuvers, and minor liver resections; and less transfusion, less ICU necessity, and shorter length of hospital stay. Severe complications were observed in 14.7% of patients, and 90-day mortality was 4.2%. Morbidity and mortality between eras were not different. From 738 CRLM resections, in Era 2 there were significantly more patients submitted to neoadjuvant chemotherapy, bilateral metastases, and smaller sizes with significantly less transfusion, the necessity of ICU, and shorter length of hospital stay. More pedicle clamping, minimally invasive surgeries, and minor resections were also observed. From 227 HCC resections, in Era 2 significantly more minimally invasive surgeries, fewer transfusions, less necessity of ICU, and shorter length of hospital stay were observed. OS was not different between eras for CRLM and HCC. Conclusions: Surgical resection in a multidisciplinary environment remains the cornerstone for the curative treatment of primary and metastatic liver tumors.
  • article 3 Citação(ões) na Scopus
    Laparoscopic Treatment of Presinusoidal Schistosomal Portal Hypertension Associated With Postoperative Endoscopic Treatment: Results of a New Approach
    (2017) COLANERI, Renata P.; COELHO, Fabricio F.; CLEVA, Roberto de; HERMAN, Paulo
    Aim:To propose a laparoscopic treatment for schistosomal portal hypertension.Methods:Ten patients with schistosomiasis and portal hypertension, with previous gastrointestinal hemorrhage from esophageal varices rupture, were evaluated. Patients were subjected to a laparoscopic procedure, with ligature of splenic artery and left gastric vein. Upper gastrointestinal endoscopy was performed on the 30th postoperative day, when esophageal varices diameter was measured and band ligature performed. During follow-up, other endoscopic procedures were performed according to endoscopy findings.Results:There was no operative mortality. One patient had a postoperative splenic infarction that was conservatively treated. Mean hospitalization time was 5 days. During endoscopy 30 days after surgery, a decrease in variceal diameters was observed in 6 patients. During follow-up (mean 84 mo), after endoscopic therapy 8 patients had eradicated varices, but 4 presented with recurrence. Considering the late postoperative evaluation, all patients had a decrease in variceal diameters. A mean of 3.8 endoscopic banding sessions were performed per patient. Two patients presented bleeding recurrence; one had a minor bleeding episode and the other had 2 episodes of bleeding varices requiring blood transfusion. In both patients, bleeding was controlled with endoscopic therapy. No late mortality was observed.Conclusions:Laparoscopic ligature of the splenic artery and the left gastric vein is a promising and less-invasive method for the treatment of schistosomal portal hypertension.
  • article 12 Citação(ões) na Scopus
    Evolution in the surgical management of colorectal liver metastases: Propensity score matching analysis (PSM) on the impact of specialized multidisciplinary care across two institutional eras
    (2018) KRUGER, Jaime A. P.; FONSECA, Gilton M.; MAKDISSI, Fabio F.; JEISMANN, Vagner B.; COELHO, Fabricio F.; HERMAN, Paulo
    Background and Objectives: Liver metastases are indicators of advanced disease in patients with colorectal cancer. Liver resection offers the best possibility of long-term survival. Surgical strategies have evolved in complexity in order to offer resection to a greater number of patients, requiring specialized multidisciplinary care. The current paper focused on analyzing outcomes of patients treated after the development of a dedicated cancer center in our institution. Methods: Patients operated on for CLM from our databank were paired through propensity score matching (PSM), and the initial experience of surgery for CLM was compared with the treatment performed after specialized multidisciplinary management. The demographic, oncological, and surgical features were analyzed between groups. Results: Overall, 355 hepatectomies were performed in 336 patients. Patients operated on during the second era of had greater use of preoperative chemotherapy (P<0.001) as well as exposure to more effective oxaliplatin-based regimens (P<0.001). Surgical management also changed, with minor (P=0.002) and non-anatomic (P=0.006) resections preferred over major operations. We also noted an increased number of minimally invasive resections (P<0.001). Conclusion: Treatment in a multidisciplinary cancer center led to changes in oncological and surgical management. Perioperative chemotherapy was frequently employed, and surgeons adopted a conservative approach to liver parenchyma.
  • article 11 Citação(ões) na Scopus
    Laparoscopic Liver Resection: A South American Experience with 2887 Cases
    (2020) PEKOLJ, J.; SANCHEZ, R. Claria; SALCEDA, J.; MAURETTE, R. J.; SCHELOTTO, P. B.; PIERINI, L.; CANEPA, E.; MORO, M.; STORK, G.; RESIO, N.; NEFFA, J.; CORMACK, L. Mc; QUINONEZ, E.; RAFFIN, G.; OBEIDE, L.; FERNANDEZ, D.; PFAFFEN, G.; SALAS, C.; LINZEY, M.; SCHMIDT, G.; RUIZ, S.; ALVAREZ, F.; BUFFALIZA, J.; MARONI, R.; CAMPI, O.; BERTONA, C.; SANTIBANES, M. de; MAZZA, O.; OLIVEIRA, M. Belotto de; DINIZ, A. L.; OLIVEIRA, M. Enne de; MACHADO, M. A.; KALIL, A. N.; PINTO, R. D.; REZENDE, A. P.; RAMOS, E. J. B.; OLIVEIRA, A. Talvane T.; TORRES, O. J. M.; CASSIS, N. Jarufe; BUCKEL, E.; TORRES, R. Quevedo; CHAPOCHNICK, J.; GARCIA, M. Sanhueza; MUNOZ, C.; CASTRO, G.; LOSADA, H.; SUAREZ, F. Vergara; GUEVARA, O.; DAVILA, D.; PALACIOS, O.; JIMENEZ, A.; POGGI, L.; TORRES, V.; FONSECA, G. M.; KRUGER, J. A. P.; COELHO, F. F.; RUSSO, L.; HERMAN, P.
    Background Laparoscopic liver resections (LLR) have been increasingly performed in recent years. Most of the available evidence, however, comes from specialized centers in Asia, Europe and USA. Data from South America are limited and based on single-center experiences. To date, no multicenter studies evaluated the results of LLR in South America. The aim of this study was to evaluate the experience and results with LLR in South American centers. Methods From February to November 2019, a survey about LLR was conducted in 61 hepatobiliary centers in South America, composed by 20 questions concerning demographic characteristics, surgical data, and perioperative results. Results Fifty-one (83.6%) centers from seven different countries answered the survey. A total of 2887 LLR were performed, as follows: Argentina (928), Brazil (1326), Chile (322), Colombia (210), Paraguay (9), Peru (75), and Uruguay (8). The first program began in 1997; however, the majority (60.7%) started after 2010. The percentage of LLR over open resections was 28.4% (4.4-84%). Of the total, 76.5% were minor hepatectomies and 23.5% major, including 266 right hepatectomies and 343 left hepatectomies. The conversion rate was 9.7%, overall morbidity 13%, and mortality 0.7%. Conclusions This is the largest study assessing the dissemination and results of LLR in South America. It showed an increasing number of centers performing LLR with the promising perioperative results, aligned with other worldwide excellence centers.